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Academic Medicine Begins ePub Ahead of Print

Kanter, Steven L. MD

doi: 10.1097/ACM.0b013e3181e8e28a
From the Editor

It seems as if everyone has a theory about electronic publishing (ePub) ahead of print. Some believe that it will speed publication time, while others think it will enable a journal to publish more articles. Some think it means that journals will no longer publish “issues” and that readers simply will access individual articles from a list of hyperlinks that just gets longer and longer. Others say that it will enable the immediate publication of accepted manuscripts. And still others are convinced that it will reduce the cost of publishing and even eliminate the need for the print versions of journals.

Since Academic Medicine began to publish articles electronically ahead of print at the beginning of 2010, I thought I should explain why and how we are doing it, address the aforementioned “theories,” and share my predictions for the future of this journal.

So, why ePub ahead of print for Academic Medicine? The main reason is that this approach allows authors to get their articles published more quickly and readers to have more immediate access to them. An article on a “hot topic”—like health care reform or the readiness of academic medical centers for a pandemic— can be made available in a more timely way (without the article having to “wait its turn” to appear in a print issue). Many journals now publish articles electronically ahead of print, and there is no question that it is a good idea for Academic Medicine.

How is the journal making this new approach work? Academic Medicine is phasing it in. Even so, changing part of the editorial and production process, which is a complex and interdependent system, is like changing the tires on a car while it is travelling at 60 miles per hour down the highway. And that is just the kind of activity the journal's professional editorial staff have been engaged in. To make ePub ahead of print a reality for Academic Medicine, they have had to examine every aspect of the editorial and production process—every deadline, how each one interacts with every other deadline, which staff editor does what and when—and introduce the new process while continuing to produce a monthly print version. They have to make it seem to the outside world as if the car has four tires on the ground at all times, even though sometimes, just for an instant, it has only three. From the driver's seat, it certainly is evident that they are doing a remarkable job.

How will the journal publish articles faster? Even though the ePub process can speed publication time, there is more than one way to achieve that:

  • One ePub ahead-of-print approach is to publish accepted, edited, checked, and proofread articles online prior to their appearance in the print version of a journal. Such an article, published ahead of print, is an official publication of a journal, is assigned a DOI, and is indexed by PubMed and other indexing services. (DOI is an acronym for digital object identifier, a character string that serves as a unique identifier for an article and stays with the article even after the article is assigned volume, issue, and page numbers. This is important because it allows an ePub article to be cited immediately by its DOI and then associated with its traditional citation after it is published in print.)
  • Another ePub ahead-of-print approach is to post online versions of an article at various stages of development, such as the accepted version that has not yet been edited substantively, or perhaps a version that has been edited substantively but has not yet been proofread.

There are other variations on these approaches, but the point I wish to make is that Academic Medicine is pursuing the former one—publishing early online the accepted, edited, and proofread version of an article that conforms to journal style and is virtually “camera-ready” for the eventual print version.

However, ePub ahead of print cannot speed up other steps in the publication process. The journal, of course, has a system for moving a manuscript from submission to review to revision to acceptance to substantive editing to copyediting and to proofreading. Value is added at each step. And quality takes time. It takes time to solicit and receive external peer reviews for a manuscript. It takes time for professional staff editors to work closely with authors to make substantive edits that strengthen arguments, improve the organization and flow of ideas, catch mistakes, and tighten prose. And it takes time to copyedit and proofread a manuscript to ensure accuracy, eliminate distracting errors, and improve overall readability. The ePub ahead-of-print process cannot speed up these tasks.

Will the new process allow the journal to publish more articles? No, because the rate-limiting step that determines how many articles a journal can publish is not really the number of pages specified in the contractual agreement with the publisher. Rather, the rate-limiting step is the level of quality to which the journal aspires. Academic Medicine has always valued substantive editing by professional staff editors. Each staff editor, of course, can substantively edit only a given number of articles per month. All of us in the Academic Medicine community are fortunate that the journal's owner, the Association of American Medical Colleges, and its leadership have made high quality a priority for the Association's scholarly, peer-reviewed publication.

So, what changes can you expect to see at Academic Medicine in the near future? The journal is moving to what is called “continuous publication”—i.e., publishing each article online as soon as it is ready, before assigning it to an issue. In fact, by the end of this year, if all goes according to plan, the journal will be publishing every accepted article ahead of print. Of course, this raises the question of whether or not the journal should continue to publish print issues.

I see two questions buried in the one. First, should we continue to produce issues? And, second, should we continue to offer a print version?

In my August 2009 editorial, “An Issue of a Journal Is More Than the Sum of Its Parts,” I made the case that an issue adds value by bringing together in one place a set of articles and research reports, commentaries on some of these, art, letters to the editor, and other features. I wrote that an issue

has the potential to bring coherence to a set of ideas, beyond what any one article in the collection could do alone. A well-crafted issue can stimulate thinking in new and creative ways, lead to a cross-pollination of ideas that traverse traditional disciplinary boundaries, catalyze dialogue on important controversies of the day, and even galvanize community action around critical matters.1

So, my answer to the first question is, Yes, we should continue to produce issues.

As for the second question, Yes, Academic Medicine should continue to produce a print version of the journal for some time. But I think it is safe to speculate that the print version of any journal has a finite and limited lifespan. Although I think we can predict with a high degree of certainty that the print versions of most journals will be eliminated, it is a little more difficult to determine for a particular journal the right time to stop the presses. I think it will depend to some degree on the ages and habits of a journal's readers, financial and contractual considerations, and perhaps how comfortable it becomes to cradle an e-reader while curled up on the couch in one's favorite reading spot.

What will happen in the long term? Eventually, I believe, ePub ahead of print will eliminate the need to publish a print version of this journal. However, I think it is shortsighted to assume that the future of scholarly publishing will consist of Web sites structured as we now know them.

If we believe that an “issue” offers value above and beyond what one can gain from a hyperlinked list of articles, then Academic Medicine should continue to produce issues whether or not the journal produces a print version. Certainly, I can imagine perusing the pages of an issue of this journal on an e-reader—like a Kindle or an iPad—or even some more advanced device. A digital version of the journal on an e-reader would preserve all of the added value of an issue, allow content to be packaged and repackaged in new ways, save trees by not producing a print version, and even reduce the chance of infection because you would not have to lick your finger to turn the page!

So, stay tuned. Hopefully, very soon, I will be able to advise you to pack your Kindle or iPad in your beach bag, so you won't have to wait until you get home to know what's happening at medical schools and teaching hospitals.

Steven L. Kanter, MD

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1 Kanter SL. An issue of a journal is more than the sum of its parts. Acad Med. 2009;84:975.
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